Type 2 diabetes is progressive in nature and many people with the condition will inevitably require insulin therapy to attain and maintain adequate glycaemic control. In clinical practice, insulin initiation is delayed in many patients who would benefit from such treatment. Patients' and physicians' beliefs and perceptions regarding insulin therapy are known to create barriers contributing to the delay in its initiation. This article explores the nature of these barriers and offers suggestions and practical solutions for addressing and overcoming these hurdles so that insulin can be initiated confidently and appropriately in order to improve diabetes care. 2010 Primary Care Diabetes Europe. Published by Elsevier Ltd.. All rights reserved.

Insulin detemir provides prolonged, reproducible blood glucose reduction through a mechanism unique among basal insulins. It was originally studied clinically in predominantly basal + bolus regimens and found to be associated with a low risk of hypoglycaemia compared to insulin NPH, and reduced weight gain compared to other basal insulins. Insulin detemir has been increasingly studied in basal-only insulin regimens in type 2 diabetes, in which an understanding of how to optimize its use has been built incrementally. Glycaemic control and limitation of weight gain tend to be maximized by once-daily (evening) dosing, earlier initiation and careful titration to appropriate fasting glucose targets. 2010 Primary Care Diabetes Europe. Published by Elsevier Ltd.. All rights reserved.

Basal insulin analogues are an effective treatment for type 2 diabetes with proven efficacy, and insulins NPH, detemir and glargine have shown comparable glycaemic control. However, pharmacokinetics and clinical studies highlight the advantages of insulins detemir and glargine over insulin NPH in terms of once-daily dosing, reduced risk of hypoglycaemia, reduced within-patient variability, appropriate duration of action and simple titration. Insulin detemir has demonstrated the additional advantage of less weight gain. Introduction of insulin detemir, at the appropriate time, can help empower patients to reach glycaemic targets, with a reduced risk of hypoglycaemia and less weight gain. 2010 Primary Care Diabetes Europe. Published by Elsevier Ltd.. All rights reserved.